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HomeMy WebLinkAbout3170DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -23.4 BOX 26 17%. i r , r4 �%Kl Ll kr 41 .� Ir al 1 03170 i r , r4 :i ` . Ll kr 41 .� Ir al 03170 ov v PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH _SERVICES. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR a TMENT SYSTEM PCHD CONSTRUCTION PERMIT # PV- 34-- Dd Located at )._ 14t ?M 6 H-©c.-i..cn L3 RC741s Town or Village Owner /Applicant Name P R LU,,,Ah'� t Tax Map Z P Block �_ Lot ?-3,4 Formerl Subdivision Name W H G P4P-cEL_ It Subd. Lot # 4 Mailing Address g ( FP_!1 0 . ibys 1—lSN-KI uc— ti, Y, Zip 1'ZS"Z Date Construction Permit Issued by PCHD 0 f I l V Separate Sewerage System built by LEE- M-KAER- Address /A,4H0PAC , ti%.?` Consisting of 1,5-00 Gallon Septic Tank and 4P,_7 L, =, OF 2-4 ' AJGH Uy l _�L Other Requirements: Water Supply: Public Supply From Address or: X Private Supply Drilled by � r, REAL_ Address aR- cW- _rCC_P -4 i'-Y, F u;.lding TyYe S! _i= a'�';` /4 E. Has erosion control been completed? Y� S - Number of Bedrooms S Has garbage grinder been installed? Aj o v I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Put M County Department of Health. Date: I Ill6 /D 1 Certified by (Design Address a 4lac Y f - IA)k oZ. e, , L P.E. X R.A. License # P 4 Z -5—®-C' Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio , m difica n or change is necessary. By: Title: �G" Date: % J3 D White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 BADEY & WATSON Surveying & Engineering, AC. 3063 Roiite 9, i2olid 'Spring,' New Y6rk 10516 (845) 26579217 (914) 628-1800 (914) 739-3577 (845) 225-3312 FAX (845) 265-4428 TO: Adam Stiebeling Putnam County Department of Health I Geneva Road' Brewster, NY 10509 We are sending: LETTER of TRANSMITTAL ba*te7' '27 Dec 2bof File No. 98-105 W. O. # 14383 RE: Lusard! Horton Hollow Road Westchester Holding Co., Inc. Par Subd. Lot No. 4 Tax Map 72.4-23.4 Permit # PV-34-00 Sent via: US MAIL E j UPS-NIGHT OV MESSENGER UPS-2 DAY ❑ PICK-UP UPS-3 DAY FAX _1 UPS-GROuN ❑ UPS-COD F-1 copies date description of document n Fee F-1 I 5_-J2e_c-o_1_= [Api �caFo -­ - --- --- ------ L 11 26- Nov -01 Certificate of Construction -Compliance for Sewer Treatment -System .... ..... 73 19- Nov -01 i Guarantee of Subsurface Sewage Treatment System 71 16-=yo0�_?j Well. Water Test Results su6 ------ -------- ...... ..... 711 125- Oct -01 L LelLCompletion _L ep or ... ... ----- 1911 Address Verification Form f-3]. .7122--Oct-OF-7 [§§T "As-Built" --- ------- 7i El i El . L- - - - -- - - -- - REMARKS: Signed: John P. Delano, P.E. Copies to: File Y0j PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT JWN f�.5: Horton ­[Map 1Z Block I Lots) Hollow Road, Lot #4 Putnam Valley t( Well Owner: Name: Address: Martin Homes, Inc., 24 Tgood Lane, Mahopac, INY 10541 Use of Well: 1-primary 2-secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _ Cable percussion X Compressed air percussion — Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 52—ft. Length below grade 51 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel —Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No ILiner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) i Developed? First Yes—No Hours Second Well Yield Test Bailed XPumped X Compressed Air Hours 6 Yield L gpm Depth Data Measure from land surface-static (specify ft) 301 During yield test(ft) 1201 Depth of completed well in feet 1651 Well Log If more detailed information descriptions or sieve.analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 20 Drilling in over )urden clay, and boulders 20 Hit rock at 201 20 in..-x. ck -set, casing, . grouted. 52 165 in -ro(fic aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type sub Capacity 7cr Depth 140' Model 7GS05412 Voltage 230 HP '-2 /1 Tank Type N-,1002 Volume a Date Well Completed 8/24/01 I Putnam County Certification No. 002 I Date of Report 10/25/01 -Ter Well Driller =g r NOTE: Exact location of well with distances t ast two permanent landmarks to be provided coi a separate sheet/plan. Well Drillees Name P. F e Tnt- Address: 4 Putnam Aye. , Brewster, 1Y 10509 Signature: Z M/01// Date: 10/25/01 I Perry K. al White copy: HD File; Yflow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 a a -e BRUCE R FOLEY *, * RET A. M ARI R N., .M. S.N. LO T OLIN S N ablicCieaah-Dini;s.0i' C' c,SwGlaiw ii uviY� ir�ai�u :uEciC Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 -.6558 . WIC(914)278-6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Philip & Robin Lusardi TAX MAP NUMBER: 72.-1-23.4 E911 ADDRESS: Hr-).Y' TOWN: TOWN OF PUTNAM VALLEY AUTHORIZED TOWN OFFICIAL: ' y/UJ JVVU v L0 (Signature) G/ DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance.. (E91 IVERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALT H SERVICES Philip & Robin Lusardi Owner or Purchaser of Building Martin Homes Building Constructed by 15 Horton Hollow Road Location- Street Residential Building Type 72. 1 23.4 Tax Map Block Lot . Mahopac, NY TownNillage Westchester Holding Parcel H Subdivision Name Subdivision Lot # 4 I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. ° ==ile irdieiignedurt'ur-agree3 tb aecepa c6�crisve tildeieriniaiiori.of the Yunlic ITealth - Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Mo th / Day � Year o 1 i neral C ntr C4 Nwn`er) Signature �6 :FW C, Corporation Name (if corporation) Address: �,q State- Zip [Os Ht Signature: Title: Corporation Name (if corporation) Address: State Zip Form GS -97 N, NORTHEAST LABORATORY of DANBURY �N i_ __39 MILL PLAIN,ROAD.._ - DANBURY� CT 06811 CT Cert PIS- 0404. - 9oA�o •:,... ��, : � ��i� 148_`P�s - rf� 1�i53)' /4g= "iY6'S� "�" 1�5CCert: ""1�4�11 ...., -' U � ._. LABS www.NORTHEASTIABORATORIEES.com < z REPORT TO: P.F. BEAL & SONS DATE SAMPLE COLLECTED: 11/13/2001 4 PUTNAM AVENUE TIME COLLECTED: 10:30 A.M. BREWSTER, N.Y. 10509 COLLECTED BY: PLB DATE RECEIVED @ LAB: 11/13/2001 TESTED BY: LAB #11471 LAB I.D. # PFB -117 REPORT DATE: 11/16/2001 SAMPLE SITE: MARTIN HOMES, HORTONTOWN HILL RD., PUTNAM VALLEY, N.Y. SAMPLE POINT: HOSE BIB SOURCE: WELL TREATMENT: NONE MAXIMUM CONTAMINANT TEST PERFORMED RESULTS METHOD # LEVEL (MCL) OR STANDARD BACTERIAL: • Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml PHYSICALS: • Color (Apparent) 3 - EPA 110.2 15 • Odor ND - - 3 Units • pH 7.17 - EPA 150.1 No designated limits • Turbidity 0.42 NTUs EPA 180.1 5 NTUs CHEMISTRY: • Nitrite Nitrogen <0.005 mg/L as N EPA 354.1 1.0 mg/L asN EPA 3:`.•3;? ; _.- _...: lOm,.. AllaluuTy 12.0 mg/L SM 2320B " No designated limits • Hardness 16.0 mg/L EPA 130.2 No designated limits • Iron . <0.03 mg/L EPA 236.1 0.30 mg/L • Manganese <0.01 mg/L EPA 243.1 0.50 mg/L Combined limit for Iron phis Manganese = 0.50 mg/L • Sodium <1.0 mg/L EPA 273.1 20.0 mg/., ** • Lead 0.001 mg/L EPA 239.2 0.015 mg/L * ** ml= milliliter mg/L--milligrams per Liter ND =none detected MCL= Maximum Contaminant Level TNTC =Too Numerous To Count * *Notification Level * "Action Level COMMENTS: -All holding times (were) met. SAMPLE, AS TESTED ABOVE: MPOTABLE or ONOTPOTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTTAAB LE WATER) RESULTS BASED ON SAMPLES SUBMITTED: 11/13/2001 Laboratory Director ®NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 � q A UTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL, HEALTH SERVICES PERMIT # -3 -a 0 9/7 Located at 602JON 4D ..0 W K(} Aj--'> Town or Village Py TM UZ LE l( 1✓ Si' ' ' B1Qi�N� Subdivision name EL,,PARCELU Subd. Lot # d�f_ Tax Map 72. Block t Lot '21, Date Subdivision Approved M 149CR I0,' 000 Owner /Applicant Name Pj+l UP 4 PD.& 'J d'. USM,-D 1 Renewal Revision Date of Previous Approval Mailing Address 9 BER&6OFF bQ,A ; F X540 LL tj Zip Amount of Fee Enclosed 00 Building Type (ZG31 b &MAL_ Lot Area .DW o- of Bedrooms � Design Flow GPD�0 Fill Section Only Depth Volume PCIID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Sgparate Sewerage System to consist of Other Requirements: To be constructed by HAR80 L:` oNS t SONS Water Sup"I Public Supply From _ gallon septic tank and (all F' — 2-4 SPAC9b AT to FT 0 -C Address C.Ol b S Ppi Q �- , L Address or:-.- _Private S �ppl;� 'nrP�e, i` ��. �'�•: ;C: Z'l cy = +. I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date 00/ 0 i 00 License # ®62.,, APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the r sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plarl requires a new Approved f is arg f d estic sanitary sew a only. By: Title: Date: j White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professid6l Form CP -97 e a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLIC O NSTRUCT A WATER WELL H t �.w' o� .. please pruu or typo - _� r %cfr1i1 Well Location: Street Address: Town/Village Tax Grid # tloQ-Tm RoLwvi Zb N`-WNA Map '-72- Block i Lot(s) Well Owner: Name: P1+1 UP � fig; N Address: i.....uS491)i 18 'BC-R&140FF'ba. F 4K -1LL. zsZ Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served �_ Est. of Daily Usage IQ (3 gal . Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Ud` l✓ WkTE P. GOP- MEW NC- - for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision S-TCHESTER { -IoUbi O&M, :LM C PARCEL Lot No. Water Well Contractor: C(Z1e1 0A) 132DS, Address: (S •L Is Public Water Supply available to site? .................................. ............................... Yes No C� _ Name of Public Water Supply: A114 Town/Village /V � Distance to property from nearest water main: > 1 1 Le Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: Applicant Signata -rP' kJ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well drillW*fied am Co unty. Date of Issue Q Permit Iss g Official: Date of Expiration ,o Title: Permit is Non- Transferrabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at Lusardi Horton Hollow Road 2.3,x} T/V Putnam Valley _ Tax Map # 72 01 Lot .__ pOag Subdivision of Westchester Holding Co., Inc.. Parcel II Subdivision Lot # 4_Filed Map # _ 2824 .-. Date Filed - -March 10, 2000 __ Gentlemen: This letter is to authorize John P. Delano a duly licensed Professional Engineer x or Registered Architect — to apply for the required wastewater treatment andlor water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public H ealth Director of the Putnam County H ealth Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public H ealth Law, and the Putnam County Sanitary Code. Countersigned: P.E., # _.. �. - - - -- 62505- - - - - -- Mailing Address Badey & Watson 3063 Route 9, Cold Spring State New York _Zip 10516 Telephone: 845- 265 -9217 :. . -Very truly yours, Signed: ner of Pro ) Mailing Address: 8 Berghoff Drive Fishkill State New York Zip_ 12524 Telephone: _845- 592 -3427 Form LA -97 r u l rr "t C:UUI\'TY DEPARTlIENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE MPECTION :tom - _. Date: 3 Inspecte 5/ Street I locMa tL �i�c,t oc,J Owner TM U Subdivision Lot 1. &Nvage SvstetU Area a. STS area located as per approved plans :.......................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Seii%ge System SOv a. Septic tank size -1,000 ..... W.... other ................. b. Septic tank installed level ................ ............................... c. 10' minimum from foundation.. .. ............................... d. 'stribudo Box . -All outlet at same elevation -water tested ................. 2. Protected below frost ............... ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction o -properly set ........... ............................... f. Trenches T Te —ngth required Cv Length installed 2. -Distance' -to watercourse measured - Ft.:........ 3. Installed according to Ian ............ .. ............ :.:........ 4. Slope of tre cep ble 111 2" /foot ..... :....... 5. 10 ft. prope 1 e-2 - undations ...... ,... 6: Die trench 0 ' the o surfac .................. 7. Ro allowed f ex on, 00 ....................... 8. S' a of gravel 4 -1' " i t ean........ ............. 9. p of gra in tre ' 12" minimum ................... 10. pe ends ppd....... ............... ..........:.................... Q.Ulft CT)(1_ .r 2. 3. 4. - - - -- - 5. 6. I7I. our Overflow tank ....:........................ .....:......................... Alarm, visual/audio. .......... ............................... Pump easi a essi anhole to grade .......:......... . First boxbaffl -. - -- Cycle witnesse y H. . sfimated flow /cycle........... e/BulldinL r a. douse local N b. Number of approved plans ........................ 1......... s............. .............................:. .. ell a: Well locate as p appro v Tans ... . ..... ........... b. Distance fro ST area ft ........... c. Casing 18" v r .......................... ....... . .... ... d. Surface drai a aro d well acceptable ..................... V. Overall Workm sh' a. Boxes properly grouted ................... b. All pipes partially backfiiled ................... ...... ... c. All pipes flush with inside of box ......................:. ....... d. Backfill material contains stones <4" diameter ............. e. 'Curtain drain & standpipes installed according to plan. f. Curtain drain outfall protected & dir.to exist watercoui g. Footing drains discharge away from STS area .............. h. Surface water protection adequate . ............................... i. Erosion control provided ................ ..............................• n _.. e,n-r BADEY & WATSON LETTER of TRANSMITTAL Surveying & Engineering, AC. _ D 28 Aug 20 ~ {3063 ttdute y," Cold Spring,- ivew :Yuric 110510 - ate. (845) 265 -9217 (845) 628 -1800 (914) 739 -3577 File No. 98 -105 FAX (845) 265 -4428 W. 0. # 13423 RE: Proposed SSTS Lusardi TO: Horton Hollow Road Adam Stiebeling Westchester Holding Co., Inc. Par Subd. Lot No. 4 Tax Map 72: 1 -p /023 Putnam County Department of Health permit # 1 Geneva Road Brewster, NY 10509 Sent via: US MAIL ❑ UPS -NIGHT MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GROUN ❑ UPS -COD ❑ We are sending copies date description of document Ol 128-Aug-00 lConstruction Permit for Sewage Treatment System ❑1 101-Aug-00 Letter of Authorization F-1] 28- Aug -00 i Application for Approval of Plans for a Wastewater Treatment System Ol 101- Aug -00 IShort Environmental Assessment Form _ —� F T 2-8- IDesign Data Sheet C `*J 28- Aug -00 ISeparate Sewal stem Sheet 1 of 1 01 -Aug 00 Floor Plans -- _ -- -_ - - -- - --- �O1- Aug -00 Application to Construct a Water Well M E -0 28- Aug -00� A lication Fee (Previously submitted) REMARKS: Signed: John P. Delano, P.E. Copies to: File 4029 Appi-oxi►iale.ly :3208 sq. fl. of space. Drawings are for itillstrali))n only ait(l inay vary in pi•ccise detail froin plans and specitic.ations. Df Durcl-jiuSs I Room KITCHEN Two STORY 15'0"x 13'0". NOOK 131. so. FT. 194 so. FT. 227" x 13'0' H-354 BEDROOM #4 I TO" 12'8" B-2 2 BEDROOM #3 10'8" 13'0" UnLrry . x 137 so. FT. > 56 6 Fl Fr gHALL x 138 so. FT. W.I.C. LIVING Room OPEN TO B-3 OWN!Fz� 20'5" x 13V 265 so. Fr. ABOVE 55 SO. FT. M v 6. 00, ON AS i 2r2, ti I b5B &Q. :1 1 66,9�,G180FF J V O 186 SO. FT. Y__� LL, N z_S72-q 38 BoNus Room L-0 c-AX-ri C) i\j BEDROOM #2 OPEN TO W. I. 78 40V—Tom 19'8" x 9'4" BBDw SO. Fr. _t PUTfQ Arn V AILIE4 183 so. FT. 6,Q c,ouN-r\4 a. CO. INC PRUJErL 7tt- 5econd -T Fl-c)ol- L ID T rv\ - __7 lid 103' -PUTNAM COUNTYDET HOUSE PLANTS APPROVED FOR BEDROOMS 'ALL SUBSEQUENT REVIStUN/Al PLANS MUST BE SUBMIT'BM I SIGNATURE _8z TITLE First Fk)oi- 7-1 Lia N C) .. 9 (2) -1 C) 5 ITMENT OF, HEALTH EDROOM COUNT ONI ERA' IILE RN�TH �T 0 THE P R AL. Z DINING Room KITCHEN 15'0"x 13'0". NOOK 131. so. FT. 194 so. FT. 227" x 13'0' 253 so. FT. �"I" D N UnLrry . LIVING Room OPEN TO B-3 20'5" x 13V 265 so. Fr. ABOVE RAISED FOYER 161 6. 00, ON AS i 2r2, ti &Q. pppppl CHE LISEA'.. MODULAll." HOME,i 01111 Route 9W, Marlboro, New York 12542 e (914) 236-3311 BRUCE[ R. F/OLEY LORETTA MOLINARI R.N., M.S.N. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 August 24, 2000 Mr. John Delano, PE Badey & Watson 3063 Route 9 Cold Spring, New York 10516 Re: Application to Construct a Subsurface Sewage Treatment System on Horton Hollow Road, Westchester Holdings R.S. Lot #4 Town of Putnam Valley Dear Mr. Delano: The. Putnam County Department of Health (Department) has determined that the above referenced application, received by the Department on August 9, 2000 is incomplete. Please be advised.that the following information is required before the Department may commence its review. t. Correct parcel tax map number on all plans and documents. • Well dimensioned to both property lines on plan. • Correct Town as listed on application form CP -97. The review of your application will commence once the Department receives the requested information and determines that the application is complete. The Department will notify you within 10 days of its receipt of the requested information as to the completeness of your application. Please be advised that failure to submit information to the Department or to follow procedures is sufficient grounds to deny approval, pursuant to the New York City Department of Environmental Protection Watershed and Putnam County Department of Health regulations. Should you have any questions or care to discuss this matter further; please contact me at. (845) 278 -6130 extension 2157. Very truly yours, &L&.4zK-- Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Encl. - Entire submission TVI Tvl Tvl i ' f fD D, :D D - - O O O O r D C C C C r m m m m ...,.a -... �..,..._ •.... . C - :•,.,o- •,.ae.c�p, ... .. -. �.- :�..ru -..:s : L; � . :.:.: r... r••,. ..?'<�+.. ... ��_a......a.ea:.'x.. .a... .� .:.c•..y. _J- ,_i.t- ••►_ .. u+.a.. v ".v... - .. . 'i•_ ::. - «4.`y„•�.:�- O 160.9' nla r 0 Lr) 00 00 0) 14- 1 x LLJ z 0 Ld ­7 1 ------ AS-BUILT RELOCATION - DIMENSIONS 1 A 39.5' SEPTIC TANK. INLET .1c 52.3' SEPTIC. TANK INLET, 2A 32.8 SEPTIC TANK OUTLET .2C 60.8' SEPTIC TANK OUTLET, 3A 38.4 DROP BOX 3B 62.4' DROP BOX 4A 84.0 DROP BOX 4B 116.8' DROP BOX 5A, 118.0 END LATERAL 5B 143.0 END LATERAL 93.0 END LATERAL z - L*T E RAL- 7A .149.5 WELL 7C. 132.8 WELL 8A 23.5' CLEANOUT .8C 72.0 CLEANOUT 9A '32.5' CLEANOUT 9B 55:6' CLEANOUT 10A 28.3 END OF SLEEVE 10B 53.7' END OF SLEEVE 11A '11.4' END OF SLEEVE 11 c 91.9 END OF SLEEVE S57*00'007_ BADEY & WATSON LETTER ®f TRANSMITTAL Surveying sii Enineerang, 3�631toiife 9; "rold "Spring, New York 10516 Date: 01 Aug 2000 (845) 265 -9217 (845) 628 -1800 (914) 739 -3577 File No. 9 8-105 FAX (845) 265 -4428 W.O.# 13423 TO: Adam Stiebeling Putnam County Department of Health 11 Geneva Road , NY 10509 RE: Proposed SSTS Lusardi Horton Hollow Road Westchester Holding Co., Inc. Par Subd. Lot No. 4 Tax Map 72: 1 -p /o23 Permit # Sent via: US MAIL ❑ UPS -NIGHT ❑�/ MESSENGER ❑ UPS -2 DAY ❑ PICK -UP ❑ UPS -3 DAY ❑ FAX ❑ UPS -GROUN ❑ UPS -COD ❑ We are sending: copies date description of document F-1] 101-Aug-00 Construction Permit for Sewage Treatment System F-11 101-Aug-00 Letter of Authorization ❑1 01- Aug -00 ,Application for Approval of Plans for a Wastewater Treatment System l 101-Aug-00 7 IShort Environmental Assessment Form ❑1 01- Aug -00 –7 Design Data Sheet �4 O1- Aug -00 -17 ISeparate Sewage Treatment System Sheet 1 of 1 i O1 -Aua or Plans._.. X01- Aug -00 Application to Construct a Water Well 1 101-Aug-00 7 jApplication Fee $300.00 MONEY ORDER ❑ 1 711 REMARKS: Signed: John P. Delano, P.E. Copies to: File 3889 7 �R, 14164 (11/957 -- Ted 12 PROJECT I.D. NUMBER 617.20 SEQR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM . - - . _ LISTER ACTIONS Qnly,.._._ .. ,.... .... .... PART I= PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICANT /SPONSOR 2. PROJECT NAME Philip & Robin Lusardi Lusardi 3. PROJECT LOCATION: , Municipality Putnam Valley County Putnam 4:. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) (see location map provided) Horton Hollow Road 5. IS PROPOSED ACTION: ®New ❑Ex ansion Modification/ alteration 6. DESCRIBE PROJECT BRIEFLY: New Residence with SSTS 'aiid private water supply 7. AMOUNT OF LAND AFFECTED: Initial) <5 acres Ultimately <5 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING-OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes El No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑ Agriculture ❑ Park / Forest / Open space Other. Describe: Single Family Homes on 2+ acre lots 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑No..-_ If yes, list agenol(s) and permi! /appr^Jrals _ Town of Putnam Valley: driveway & building permits 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? []Yes ®No If yes, list agency name and permit /approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/ sponsor name: John P. Delano P.E. Engineer for applicant Date: Mial I W Signature: "v If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART 11 - ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NY.CRR PART Ii 17.4? If yes, coordinate the review process and use the .FULL EAF. ❑ Yes ❑ No EL WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCFUR, PART 617.6? If No, a negative declaration may be superseded by another involved age6cy. V C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems?Fxplain briefly: C2. Aesthetic agricultural,'archaeological historic, or other natural or cultural, resources: or community or neighborhood character? Explain briefl� C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: 04. Acommunity's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain brlefh, C5. Growth, subsequent development, or related activities likely to be induced by the, proposed action? explain briefly. 06. Long terT-, short term, cumulative, or other effects not identified in C1 - C5? Explain briefly. G7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. WILL THE PRO ECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? ❑ Yes ❑ No E IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO'POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes, explain briefly PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSI-RJCTIONS For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with'its (a) setting (i.e. urban or rural); (b) probability of occurring; (C) duration; M irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations Contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question D of Part 11 was checked yes, the determination and significance must evaluate the potential impact of the proposed action on the environmental Characteristics of the CSk ❑ 13heckthis box if you have identified one or more potentially large or significant adverse impacts which IVAY occur ir� * F and/or prepare a positive declaration. CCU �hen proceed directly to the RJLL EA theck -ffiis box if you have determined, based on the information and analysis above and any supportinq idocumentation, that the proposed action WLLNC)Tresult in any significant adverse environmental impacts ANDprovide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency afij'bvor TypeANam of Fesponsible Officer in -Lead Agency Title of Fbsponsible Officer Signature of Responsible Officer In Lead Agency Date" � K onv I,j j -1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ .... _DESIGN DATA SHEET - .SUBSIJV_IF,A.C-F SEIV A C'E Owner Philip & Robin.Lusardi Address 8 Berghoff Dr., Fishkill, NY 12524 Located at (Street) Horton Hollow Road Tax Map 72 Block 1 Lot 23.4 (indicate nearest cross street) Subdivision Lot #4 Municipality Putnam Valley Drainage Basin Hudson River SOIL PERCOLATION TEST DATA Date of Pre- soaking 01/07/99 Date of Percolation Test 01/08/99 Hole No. Run No. Time Start - Stop Elapse Time (Min.) Depth to Water From Ground Surface (Inches) Start - Stop Water Level Drop In Inches Percolation Rate Min/Inch A 1 1:25 1:50 25 19 - 21 2 13 A 2 1:50 - 2:20 30 19 - 21 2 15 A 3 2:20 2:50 30 19 - 21 2 15 4 - - 5 - - B 1 1:33 - 1:39 6 19 - 22 3 2 B 2 1:39 - 1:51 12 19 - 22 3 4 .'i:5 _ -.._ 2:64-"'1 I, ..� 12, _... � 19 .22 ... 3. 4 5 2 - 3 3 - - 4 - - 5 - - ....... .. ..3 NOTES: 1. ' ;Tests to be_repeated at same depth until approximately equal percolation rates are obtained at each per`colatiorftes`t Bole. (i.e. < 1 min for 1 -30 min/inch, < 2 min for 31 -60 min/inch) All data to be ,' subinttedfor reyiew. 2. Depth m surements to be made from top of hole. `* Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO.. 1 Topsoil Sand & Silt HOLE NO. 2 HOLE NO. Topsoil Sand & Silt Sand & Gravel Sand & Gravel Indicate level at which groundwater is encountered not encountered Indicate level at which mottling is observed not observed ' Indicate level to which water level rises after being encountered N/A Deep hole observations made by: John P. Delano, P.E., Badey & Watson, P.C. Date 06/10/99 witnessed by Adam Stiebling, PCDH Design Professional Name: John P. Delano. P.E. aN►uuuu� Address: _�_ Badey &Watson, P.C. §%0F 3063 Route 9, Cold Spring, NY 10516 Signature: Design Professional's Seal 2 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ APPLICATION i FO_ R APPROVAL SOF ` PLAN S-Ej O_R : � i E- 1,11Ta 11k . - AT' l 1. Name and address of applicant: Philip & Robin Lusardi 8 Berghoff Drive Fishkill, NY 12524 2. Name of project: Lusardi 3. LocationT /V: Putnam Valley 4. Design Professional: John P. Delano, P.E. 6. Drainage Basin: Hudson River 7. Type of Proiect: X Private/Residential Apartments Office Building 5. Address: Badey. & Watson, P.C. Rt.9 Cold Spring, NY 10516 Food Service Institutional Realty Subdivision Commercial Mobile Home Park Other (specify) _ 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ----------=-------------------- ----- ------ -------- ---- - - - - -- Type I E Exempt Type II U Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ---- -- ----- ------ -- -- -- 10. Has DEIS been completed and found acceptable by Lead Agency? .................... N N/A 11. Name of Lead Agency P.C.D.H. 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ------------------------------------ - - - - -- 27. Is any portion of this project located within a designated Town or State wetland? Yes 28. Wetlands ID Number N/A r.. 2.y. is vve��ar�us ertY�I rEqu�r -- , ... ------------------------------------------------------ ---- - - - -- Has application been made to Town or Local DEC office? -------- --------- ------------ - - - - -- N/A 30. Does project require a DEC Stream Disturbance Permit? - -- ---- ---------------- ----- - - - - -- No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ----- --- - - ----- --- ------- - -- --- Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any .other potentially known source of contamination? ---------------------------- - -- --- Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? - ------------------- -- --- - - - -- Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? -------------- ---------------------------------------------- ---------- - - - - -- No 35. Are any sewage treatment areas in excess of 15% slope? ---------- ----------------- -- -- - - - --- No 36. Tax Map ID Number Map 72 Block 1 Lot 23.4 37. Approved plans are to be returned to ----- Applicant X Design Professional . NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be- sent to the Depar.e:; ±; and need -_n_ot be sPnt.in.duplicate.to the DEP, although the project may quire DEP z ... ..y mil, approval of the SSTS prior to final approval by -tile Uepartinent. Projects wicitif icia watG�sl�GU r��ay also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item 1.,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.4 of the Penal Law. SIGNAT URES & OFFICIAL TITLES: y Engineer for Applicant Badey & Watson, P.0 ling 44dress- --------------------------------- - - - - -- 3063 Route 9 lkla Cold. Spring, NY 10516